A Staff-Directed Electronic Medical Record Alert to Increase Chlamydia Screening

Importance: Chlamydia is the most commonly reported sexually transmitted disease (STD) in the US. Screening sexually active females 24 years or younger is recommended to prevent pelvic inflammatory disease and its sequelae; however, screening remains suboptimal. Objective: To assess whether an automated electronic medical record alert directed at medical assistants who are preparing patients for office visits increases chlamydia screening. Design, Setting, and Participants: The STD Testing in Outpatient Practices (STOP STDs) Study was a cluster randomized clinical trial conducted from August 2017 to November 2019 (data analyzed from August 2022 to July 2023). The study included medical staff in primary care and obstetrics-gynecology offices across western Pennsylvania. Interventions: Offices were randomized in a 1:1 ratio to receive a real-time electronic alert or usual care. The alert activated for female patients without chlamydia screening within the past year. Medical assistants received the alert while preparing patients for their visit in an examination room. Main Outcomes and Measures: The main outcome was the number of chlamydia tests ordered analyzed using constrained difference-in-differences mixed-effects logistic regression with random intercepts for practice and patient; no additional covariates were included. Results: There were 7356 encounters in primary care and 10 672 in obstetrics-gynecology (women aged 18-24 years). Chlamydia tests were more frequently ordered among patients in primary care practices randomized to the alert (497 of 3770 [13.2%]) than in control practices (135 of 3586 [3.8%]). After adjusting for baseline differences in chlamydia screening in practices, the alert was associated with an increase in test orders compared with the control group (adjusted odds ratio [AOR], 2.74; 95% CI, 1.94-3.88). The alert was associated with testing in the intervention group for reproductive health-related visits (AOR, 2.80; 95% CI, 1.70-4.62) and for other medical reasons (AOR, 2.94; 95% CI, 1.78-4.85). The alert did not affect screening in obstetrics-gynecology practices. Conclusions and Relevance: In this randomized clinical trial of chlamydia screening, an alert directed to medical assistants was associated with increased odds of a test ordered in primary care practices. This study's results suggest that an alert could increase the proportion of women screened for chlamydia and reduce the reproductive sequelae of this common STD. Trial Registration: ClinicalTrials.gov Identifier: NCT03246815.